Expectations versus reality: psychology trainees’ experiences working with men

ABSTRACT

Despite increasing engagement with mental health services in Australia, therapy dropout rates for men remain high, most commonly due to a lack of connection with their therapist. Previous studies have examined the challenges men face when attending therapy, the obstacles therapists encounter when working with male clients, and the subsequent recommendations for therapist training that have emerged from these findings. However, to date there has been no investigation into the experiences and needs of trainee therapists working with men. It is unclear how their status as trainees influences their perception and adaptability when providing care for male clients. The current study therefore explored psychology trainees’ expectations, experiences, and preparedness regarding their psychotherapeutic work with men. Qualitative interviews were conducted with 12 students undertaking clinical psychology training from a single Australian University, focusing on their experiences working with male clients throughout their clinical training. Reflexive thematic analysis was undertaken to develop three themes: (1) Mismatched expectations of manspeak, which explored the ways in which students expected and experienced male engagement, (2) Gratifying work, which highlighted elements of therapeutic work with men that shaped participants’ sense of competence, and (3) Working with the “macho man”, which described the challenges of working with men, such as managing boundaries, misogyny, and personal safety. Findings suggest psychology trainees may benefit from additional training in university curriculums which specifically addresses some of the complexities of therapy with men. This training could illuminate how masculine socialisation affects men’s engagement in psychotherapy in practice and provide strategies for trainee therapists to support male engagement.

KEYWORDS:

• Men’s mental health
• psychology trainees
• psychology of men
• gender-sensitive training
• suicide

Introduction

In 2022, men made up 76% of the 3249 suicide deaths in Australia, underscoring a significant gender gap in suicide rates (Australian Bureau of Statistics, 2023). Historically, this disparity has been linked to societal factors such as traditional masculine socialisation (Addis & Mahalik, 2003; Seidler, Dawes, Rice, Oliffe, & Dhillon, 2016). Masculine socialisation is the process of learning and internalising the norms, behaviours, and roles associated with manhood within a given society (Pleck, 1995). Traditional masculine norms include physical and emotional toughness, self-reliance, dominance, honour, and invulnerability (Mahalik et al., 2003). Whilst the traditional archetype is just one of many masculinities that can be embodied by men across the lifespan (Connell & Messerschmidt, 2005), rigid adherence to traditional norms can be maladaptive to men’s mental health. For example, adherence to the traditional masculine norms of self-reliance and stoicism has been linked to reduced help-seeking and increased risk of suicide (King et al., 2020; Levant et al., 2013; Seidler, Dawes, Rice, Oliffe, & Dhillon, 2016).

Despite these social barriers to help-seeking, men’s uptake of mental health services has increased across time (Harris et al., 2015; Wong et al., 2022). For example, Wong et al. (2022) demonstrated in a representative sample of Australian men that while 7% of men accessed a mental health service in 2013, this increased to 10% in 2020. Nevertheless, overcoming social barriers to help-seeking is only one hurdle men must overcome in pursuit of mental health support, with research demonstrating more than 60% of men who die by suicide had reached out for professional help in the year prior (John et al., 2020; Stene-Larsen & Reneflot, 2019). Those men who do enter therapy, often do so with a degree of uncertainty (Good & Robertson, 2010), and as such, first therapeutic encounters are pivotal moments in their therapeutic journey. Unsurprisingly, greater dissatisfaction with previous therapy has been linked with greater doubt about the efficacy of psychotherapy and is associated with a lower likelihood of disclosing future distress to one’s general practitioner (Seidler, Rice, Kealy, Oliffe, & Ogrodniczuk, 2020). Men are also significantly more likely to drop out of therapy early compared to women (Seidler et al., 2020). An Australian study of 2009 men found 44.8% had dropped out of therapy without first discussing with their therapist (Seidler et al., 2021). Men’s perception of a lack of connection with their therapist was also the most cited reason for drop-out, supporting previous findings that the client-therapist relationship may account for the most variance in drop-out (Garcia & Weisz, 2002; Roos & Werbart, 2013). Ensuring therapists are best equipped to engage and respond to men is therefore critical to men’s retention in mental healthcare.

Therapists likewise allude to the complex nature of working with men. Therapists express more discomfort in working with men compared with women (Mahalik, Good, Tager, Levant, & Mackowiak, 2012), describe difficulty in building and managing relationships with men in therapy, and apply gendered assumptions and sometimes prejudices towards men’s abilities to engage with therapy (Seidler et al., 2021). They also express less willingness to treat suicidal men than women, which may be due to apprehension regarding their capacity to effectively work with suicidal men’s distress (Almaliah-Rauscher, Ettinger, Levi-Belz, & Gvion, 2020). Prior research exploring challenges among therapists in working with men highlighted difficulties engaging and motivating men in care, where many men were perceived as “ill-equipped” for therapy (Seidler et al., 2021). The findings spoke to a need to better equip therapists to work with men in a gender-responsive manner and have helped inform subsequent professional training programs (Seidler et al., 2023).

As a result of the difficulties in engaging men in therapy, the development of specific therapy recommendations for men is now a well-established area of research (Seidler, Rice, Dhillon, & Herrman, 2019). Studies have sought to understand why men leave therapy early (Seidler et al., 2021), how to assess men (Cochran, 2005), men’s role in couples and family therapy (Dienhart, 2001; Englar-Carlson & Shepard, 2005), alongside strategies, theoretical approaches, and training on how to best engage men in therapy (Mahalik, Good, Tager, Levant, & Mackowiak, 2012; Owen, Wong, & Rodolfa, 2009; Seidler et al., 2023; Seidler, Rice, Ogrodniczuk, Oliffe, & Dhillon, 2018). Broadly, these recommendations are encompassed by the concept of “male-friendly counselling” (Boerma, Beel, Jeffries, & Ruse, 2023), which is central to guidelines for psychological practice with boys and men (American Psychological Association, 2018). In essence, male-friendly counselling practices place the onus on the therapist to recognise some boys’ and men’s reticence towards therapy, and the associated vulnerability and expectations of emotional disclosure, as extensions of traditional masculine norm adherence (Kiselica, 2005). Corresponding practice adaptations include a focus on “microskills” of normalising help-seeking, leveraging masculine strengths to enhance engagement, and adapting language to be “male-oriented”, such as through the use of traditionally masculine metaphors (Seidler, Rice, Ogrodniczuk, Oliffe, & Dhillon, 2018).

Despite this literature, there is an overall absence of male focussed curriculum in psychology training. For example, most counselling psychology doctoral programs in the US do not offer training practices specific to the psychology of men (Mellinger & Liu, 2006). There are also three times fewer courses in the psychology of men compared to the psychology of women (O’Neil & Renzulli, 2013). Further, to the researchers’ knowledge, the only study to specifically explore psychotherapist trainees’ experience working with men is from a 1995 paper on family therapy (McDaniel, Lorenz, Waxman, & Kotze, 1995), reporting the perspectives of 4 male family therapy trainees (all of which were already health professionals; two family physicians, one social worker, and one school psychologist). This study also focused more on the experience of the therapists’ as men, rather than the experience of the therapists’ relationship to men, leaving the experience of novice psychology trainees underexplored.

To date, no research has specifically focused on the experiences of psychology trainees learning to work therapeutically with men. As a result, it is unclear whether psychology trainees encounter the same difficulties when working with men as seen in more experienced clinicians, or whether they identify training gaps for themselves in working effectively with men (Seidler et al., 2021). Trainees have an opportunity to reshape the way they engage with men in psychological care as they move into professional practice. Their novice status also potentially affords them greater amenability to novel training approaches than more experienced clinicians. It is also important to understand the experiences of trainees engaging help-seeking men across the lifespan. Men’s adherence to, and prioritisation of certain masculine norms is known to change across the lifespan, with evidence that traditional masculine norm adherence (Herreen, Rice, & Zajac, 2022) and avoidance of emotions (Kiselica, Englar-Carlson, & Horne, 2011) can be strongest among younger men. These qualities may create additional engagement challenges among trainee therapists, especially considering recent evidence of unique considerations for therapists aiming to engage young men (Boerma, Beel, Jeffries, & Ruse, 2023).

The aim of this study was to explore psychology trainees’ expectations, experiences, and preparedness regarding their work with men. This was achieved through semi-structured qualitative interviews with current clinical psychology students who had experience working with men as part of their clinical training, typically through clinical placements. A richer understanding of the perspectives of psychology trainees will allow for targeted approaches to their training, and ideally serve to improve the outcomes for men who seek their help.

Materials and methods

Design

This study is reported according to the consolidated criteria for reporting qualitative research (see Supplementary File 1; Tong, Sainsbury, & Craig, 2007). Due to the phenomenological nature of the research question, semi-structured interviews were chosen as the preferred method to explore psychology trainees’ experiences working with men (Willig, 2013). Interviews allowed the exploration of participants’ experiences in their own words, largely free of constraints, through a constructionist framework (Braun & Clarke, 2006). Ethics approval was obtained through the Deakin University Human Research Ethics Committee (HEAG-H 178_2022).

Participants

Participants were post-graduate students at Deakin University in Melbourne, Australia. All participants were either completing their Masters or Doctorate in Clinical Psychology (or had finished their program in the previous 6 months), and who had completed at least one practice (or clinical) placement featuring work with male clients.¹ Twelve participants aged 25 to 44 years (M = 31.33, SD = 6.29) were included in the study, seven of whom were female (58%). There was an even split between Masters and Doctorate students, and students reported experience working with male clients across the lifespan, primarily clients aged 12 to 60 years. Participants did not report undertaking any specific training on therapy with men prior to this study. As reimbursement for their time, participants were offered access to Men in Mind, an 8-hour online professional training program aimed at increasing health practitioners’ engagement and confidence in working with men (Seidler et al., 2023).

Procedure

Recruitment took place via a cohort-wide email, delivered by the Professional Programs Officer (an administrative position) in the School of Psychology at Deakin University. Interested participants then contacted the student researcher via email to express willingness to take part, with interviews then scheduled on the basis of convenience. Informed consent was obtained in writing prior to the interviews via forms distributed in the recruitment emails. Participants also completed a demographic questionnaire given in the recruitment email to ascertain their level of experience working with men, as well as other standard demographic information. All interviews were conducted by JS, a student researcher at the same institution as participants (in the same cohort as 4/12 participants). Interviews were conducted throughout 2023 over Zoom, lasting approximately 30 to 60 minutes in duration, with only the interviewer and participant present. The audio of each interview was recorded and then transcribed, with pseudonyms used in place of participants’ real names to maintain their anonymity. Member checking was not offered in this study. Beyond an interest in men’s mental health and shared experience as a trainee psychologist, no other characteristics were reported about the interviewer. No repeat interviews were carried out.

To explore the research in as rich a manner as possible, the interview addressed three key elements; (1) participants’ expectations about working with men, (2) participants’ actual experiences working with men, and (3) participants’ preparedness to work with men in the future. Questions started broadly (e.g. “What comes to mind when I say ‘therapy with men’?”), and further prompts asked as necessary to explore the nuances of working with men (e.g. “Prior to your first placement, were there particular types of men that you assumed would be easier or more difficult to engage with?”; Willig, 2013).

Data analysis

For data analysis, a reflexive thematic analysis (RTA) approach was employed, as per guidelines from Braun and Clarke (2022). RTA allows for a more nuanced, subjective, and in-depth exploration of participants’ experiences, aligning with the phenomenological nature of the research question (Braun & Clarke, 2006). Given the complex dynamics and cultural considerations inherent in psychotherapy with men, this approach ensures the researchers engaged critically with the data, acknowledged their own biases and perspectives, and provided a rich, contextually grounded interpretation of the participants’ narratives (Willig, 2013). As per Braun and Clarke’s recommendations, familiarisation of the data began with the researchers noting and discussing initial impressions, and rereading transcripts multiple times. The data was then coded independently by both JS and MO, and themes derived from the data, before bringing them back to the wider research team (ZS and MW) for discussion of saturation and consensus. All authors then continued to refine codes, themes, and sub-themes and reached a shared agreement for the current final analysis.

Reflexivity statement

Acknowledging the necessary and critical element of subjectivity in reflexive thematic analysis (Levitt et al., 2018), the student researcher JS, who conducted all interviews, notes his identity as a young, Australian-born male, with an interest in fostering a compassionate view towards, and healthier development of, traditional masculinities. The interviewer notes prior knowledge of the phenomena under study, in terms of interest in the wider literature on the complexities of men’s engagement in therapy. This might have influenced the direction taken in interviews and resultant findings, however we contend this mainly enhanced the capacity for the interview to connect meaningfully with participants and the collected data. A reflexivity journal was undertaken alongside the data analysis process to ensure the student researcher was critically engaging with the data in a manner that acknowledged his social positioning, and to help document key analytic choices (Braun & Clarke, 2022; Willig, 2013). In addition, active engagement in regular supervision meetings with the wider authorship team, who have extensive experience in qualitative interviewing and research, assisted JS to further develop his skills as a novice qualitative researcher. Senior author MOS supervised student researcher JS, and notes her role as a clinical psychology educator, with a passion for developing clinical psychology trainees capable of working compassionately and effectively with diverse populations. Again, whilst we acknowledge that their lens may have influenced the analysis, we also contend that this lens supported their student to consider the student and educator position in the analysis. Reflexivity was undertaken throughout the supervision and analysis phases, with discussions regarding how to best consider the data in the context of the research questions recorded after each supervision session.

Results

Three themes were developed to reflect the data, collectively charting the trajectory of a trainee psychologist’s initiation into therapeutic work with men. First, Mismatched expectations of manspeak compares trainees’ expectations with their actual experiences engaging with men, separated by two subthemes; Expecting “hard work”; and (Actually) no trouble talking!. Second, Gratifying work explores the ways in which working with men was fulfilling for trainees, separated into two subthemes; “Less psychobabble”; and Breaking through. And the third and final theme, Working with the “macho man” explores the challenges trainees faced in their work with men, in particular men identifying with traditional masculinities.

Mismatched expectations of manspeak

Mismatched expectations of manspeak represents participants’ experiences navigating various shades of masculinity in therapy. While most participants actively discussed their expectations and actual experiences with male clients, notably, some expressed an unease when addressing stereotypes and gender differences within the therapeutic setting. “I don’t want to generalise” was a statement echoed by many participants throughout the interviews, with one participant even calling it “really painful” to have to generalise about their experiences working with men. For example, when asked about expectations of difficult-to-engage subgroups prior to working with men, “Larry” responded: “I guess you could take it further and I probably wouldn’t want to just generalise like certain occupations or certain types of men based on just looking at them. But yeah, I suppose it might be more likely for men who are like less educated, potentially. And maybe men who work in like really male dominated industries, maybe like tradies or things like that.” Participants here may have been concerned that expressing generalisations about men was akin to endorsing, and thus perpetuating, them. Despite these comments, by the conclusion of their interview, most participants seemed reassured of the value in reflecting on their work with men in this way.

Most participants entered the therapeutic space with preconceived notions of how masculine socialisation would limit and dictate men’s emotional expression. These expectations painted a picture of stoicism, resistance to therapy, and emotional suppression. However, participants noted that their experiences with men served to disprove their initial expectations in many cases. Men, contrary to initial beliefs, often exhibited a readiness to communicate and challenged trainees’ expectations about male engagement:

I think I had an idea in my head that men would be more vocal about that [wanting practical solutions] and more questioning of the process, but that was definitely disproved from the guys that I worked with. They kept turning up and seemed engaged in therapy. (“Gary”)

As such, this theme captures the contrast between sociocultural stereotypes of male communication in therapy as only focused on practical solutions and devoid of emotional disclosure (Boerma, Beel, Jeffries, & Ruse, 2023; Seidler, Rice, Ogrodniczuk, Oliffe, & Dhillon, 2018), and the nuanced realities that emerged in the placement setting.

Expecting ‘hard work’

Before starting their clinical training, most participants believed that if a male client aligned with their individual perceptions of traditional masculine stereotypes, it would be more difficult to involve him in therapy. Such masculinity was described as encompassing demographic qualities such as older age, rurality, and a blue-collar profession, along with traditionally masculine interests, such as sport and cars, as well as a reluctance to express emotional vulnerability.

Yeah, I think I would have probably imagined that more that sort of typical macho man … or like … really masculine type man, you know, doesn’t really want to show any weakness or doesn’t want to show any emotions. I thought that they would be harder to engage. (“Larry”)

Many participants expressed an expectation that men would be more “closed-off” and thus harder to engage. For example, “Nole” anticipated that men might be vocally sceptical about the value of therapy and that he would have to “work very hard to engage them and actually get them to speak … that they might be a bit more passive in the session”. Conversely, he expected “men with more effeminate traits [to] be easier to engage”, where “the stereotype is that they’re more in touch with their feelings, or process their feelings in a more feminine way”.

(Actually) No trouble talking!

Despite the nature of their pre-conceptions, participants found that their actual experiences across placements challenged and broadened their perceptions about how men engaged in therapy. Some noted their surprise that “guys did actually rock up to therapy and [wanted] to engage” (“Gary”) and that “from session one, they … really easily communicated how they were feeling actually” (“Sonya”).

But I’m just like, reflecting on a couple of the men that I’ve worked with recently, and like, just time and time again, I’ll meet with them, and I’ll talk with them. And they’ll, they’ll just engage in exactly the way that I hope they will engage. And if anything… for some of them … particularly the older ones, there’s this like, permission to be like, “Oh, my God, here’s this person whose job is to listen to me talk about my life and my feelings, I’m gonna tell them everything”. (“Nathan”)

Importantly, despite expectations, nobody referenced difficulties with getting men to talk, describing them as “open” and even “very talkative, to the point where I actually had to work to contain and focus the session” (“Nole”). Implicit in these responses was participants’ surprise at their male clients’ willingness to engage.

In general, the gap between participants’ expectations and actual experiences of men’s engagement in therapy was recognised by them as significant:

… I haven’t really thought about [expectations and experiences of working with men] much until now. So, as I’m sort of going through it, I’m thinking that like, there’s probably not much distinct difference [between men and women] that I have noticed in my small amount of time working. A lot of that is based on expectation, which then is not met. So, I think I almost feel like maybe the expectations I would have if I was to lean into them, it would be quite harmful for the process. Because if I don’t think this person is willing to open up, and I give off that implicit idea to them, then they’re probably not going to open up. Whereas I’ve been trying to be as ready and like confident in their ability to do that and show them that you’re confident that they can do that, it gives them permission to actually try. (“Nathan”)

Gratifying work

Despite trainee’s expectations, many participants readily highlighted the ease and pleasure they experienced when working with men. They identified patterns across male clients which made therapy more seamless for them as trainee therapists, such as candour and humour. Participants also described the ways in which therapy with men brought out what they perceived as their own strengths as therapists, in terms of their capacity to authentically connect and establish therapeutic rapport with male clients. Many participants also referred to a gratification when working with men who were new to the experience of exploring and expressing emotional vulnerability.

‘Less psychobabble’

Participants found it easy to discuss the enjoyable aspects of engaging men in the therapeutic space. They described therapy with men as often funny, light, playful, and simple, and many referenced the ease with which rapport was built with them. Others also expressed their appreciation of the transparency that men brought to the therapeutic space, noting “it felt easy-going sometimes, felt straightforward, and like there’s less guesswork” (“Irene”).

Participants also commented on the way they adjusted their therapeutic approach in response to these qualities. Many reported the use of more casual language with men, and that this often led to a more authentic experience for the therapist themselves. One participant put it clearly:

I like the psychologist version of me that is in the room with male clients. I feel like it’s more authentic. It’s less, like, psychobabble. It’s less of … all the stuff that I find a bit tricky anyway. (“Irene”)

These comments suggest that for many trainee therapists, working with male clients allowed them to let go of any perceived need to play a more “perfected” therapist role. Instead, they could embrace their genuine, evolving selves as trainee therapists.

I sensed that there was an appreciation of candour and being frank, and I felt comfortable saying when I wasn’t sure about something or when I didn’t know, you know, what the solution to something would be, and I think that was really appreciated by at least one client who I kind of had that dynamic with. Yeah, I think he just appreciated me being kind of straight up, and so that was nice for me because I felt like I could be authentic and that was actually serving the alliance. (“Nole”)

Breaking through

Many participants expressed satisfaction when a male client – especially one who they expected to be difficult to engage – began to display greater vulnerability during therapy. “Matt” described these moments as “real gold and where I feel … most connected in sessions with men … particularly where beforehand that’s been a real no-go”. Participants noted that such experiences made the challenge of working with “difficult to engage” men worth the reward, and for many, was expressed as reason for their enthusiasm to work with men in their future career. Other participants viewed the challenge of difficult to engage men as motivating and rewarding in itself; a mark of professional accomplishment, with the closed-off man “a challenge to be won”.

… [there] was a gentleman coming, and he was 50 something. And my supervisor told me that he sought help at different places around the town, and never really engaged or stayed … then my brain went, “Oh, I’m gonna have to work hard to see if I can keep him on as a client”. I took it as a personal challenge. (“Irene”)

Working with the “macho man”

Participants also described examples of difficulty and discomfort when working with men identifying more strongly with traditional masculinities, or “macho men”. Examples included difficulties working with men who struggled to talk about their emotions, or whose views about emotional expression and gender roles and responsibilities were in contradiction to theirs.

For example, participants cited the challenge of men “who have the perception that it’s really difficult to change” (“Tracy”), as well as men who were reluctant to admit that they were struggling with their mental health, despite all the evidence indicating otherwise. “Matt” described “the challenge for [him] was trying to break that understanding of what seeking mental health support and looking into your mental health actually meant”. He noted many of the men he worked with “had this kind of preconceived idea around what it is to be a man, what it is to be masculine, what it is to provide and be in this world” and that such views were in contradiction to his “understanding of what it is to be a man”.

Other participants noticed “that the capacity to sit with emotions or talk about emotions was limited” amongst some men they worked with. However, some did not view this as a lack of willingness to engage, rather, “because [they] didn’t have it in [their] toolbox” (“Irene”). Others, such as “Nole”, saw communication difficulties with some male clients as symptomatic of avoidance. In his words, they would “acknowledge there was a problem, but [without] getting too close to talking about what the impact is on them … they were talkative but they were kind of describing external stressors, more than their internal experience”.

Some trainees also experienced obstacles working with men they perceived to embody hypermasculine tendencies, as described by “Tracy”: “the most challenging thing for me was when I came across some toxic masculinity … ”. For some, these obstacles also took the form of discomfort navigating some men’s views towards women:

Interviewer: And then conversely, was there anything that was … less enjoyable, on average, when working with men?

“Sonya”: When men would talk negatively about women. And I sometimes found that when they would do that it was more about like women as a whole … rather, than like … this specific female partner that they were talking about. Like … that was quite challenging to manage, just … like … my own … like … I guess, reactions to that.

Notably, male and female participants sometimes differed in how they experienced these various challenges in working with men during their training. For example, one male participant reflected that while his gender often facilitated a stronger rapport with male clients, the advantage was sometimes offset, when it led to presumptions of shared misogynistic views.

…as you try and develop rapport with somebody, and they start to feel comfortable, then they might feel comfortable saying a misogynistic thing that they think you will be on board with because you’re also male…that one’s a hard curveball to deal with. Pretty much just to try and like, not reinforce it, but also not rupture [the therapeutic relationship.] (“Nathan”)

In contrast, female therapists experienced their own uniquely gendered challenges. Some described trepidation in managing boundaries, particularly when the client’s actions were viewed as overtly overstepping them. “Holly” described being “more mindful and challenged … from an ethical perspective, not wanting to blur their expectations of what this therapy involved and the therapeutic relationship”. For example, she detailed “times where [men] wanted to kind of see [her] outside of session”, finding it “challenging for [her] to … set those boundaries in the therapeutic relationship from the start, probably more so than working with a female client.” Difficulties setting boundaries here manifested as safety concerns and discomfort working with some male clients, highlighting the unique gendered challenges some female practitioners can face working with men:

It was something about the way that a young 20 something year old man was engaging with me in that space that felt uncomfortable. And just, yeah, there was something about it that didn’t feel necessarily 100% safe actually … which I wasn’t expecting that to happen. I have had that experience with one client. And I think I was safe. But my body didn’t feel safe. (“Ella”)

Thinking about these challenges, participants were asked about their preparedness to work with men in the future, and what they would need to feel more prepared. Participants often stated that more experience working with men would be enough for them to feel more confident managing some of the difficult behaviours they encountered with men, particularly concerning boundary setting and misogyny. Other participants were adamant that university courses should address the lack of training for engaging male clients, as this would have benefited their early work with men, and their confidence to work with men once graduated. At the same time, they acknowledged that such curriculums were inherently limited by resources, time, and the challenge of addressing all areas of study.

[Training could consist of] conceptual ways of looking at [masculinity] or skills or strategies or whatever it might be, that you can keep in mind and have with you if it does seem like this particular guy that you’ve got in the therapy room does subscribe to a more hegemonic masculinity, is stoic, hasn’t talked about his emotions since he was four years old and he’s 40 now … yeah, I think that would be an hour well spent for all of us. (“Irene”)

Other participants viewed gender-specific training as unnecessary and were instead in favour of a focus on how to work effectively with clients who are “difficult to engage” for various reasons and irrespective of gender.

… maybe it’s more about traits and an awareness that there are certain populations that will tend to exhibit those traits, but not always, and like learning more about how to deal with the underlying traits that explain some of the differences between these groups means you’d be set up if a young girl came in with those same problems, or a mum, or something like that, I think … I would find that more helpful than just like “here’s how you work with men” as a sort of silver bullet. I think it’s more complex than that. (“Nole”)

Importantly, regardless of the challenges they may have experienced in their early placements, or their views of gender-specific training, nearly all trainees expressed a sincere desire to assist men. Participants were able to pinpoint the challenges of engaging men in therapy, whilst simultaneously expressing their respect for the root of such challenges – as one participant put it when discussing the challenge of working with men who put self-care last, “I really respect … that some men that I came across, had a really strong sense of responsibility to others. And I thought that value really came through in pretty much all of them that I came across” (“Tracy”).

Discussion

Results of this study offer insight into the complex dynamics of gender in therapy and provide guidance for enhancing training programs and professional development for trainee psychologists. Mismatched expectations of manspeak highlighted the nuanced ways in which trainees both expect and experience male engagement in therapy; generally, trainees expected men to be difficult to engage – to be resistant to therapy both ideologically and practically, particularly if they presented as “traditionally masculine”. Instead, they often found resistance to therapy rarely impeded their progress; the primary challenge lay in managing and containing the content of sessions and aiding men in connecting with their emotions. Gratifying work spoke to the enjoyment and gratification that trainees experienced when working with men. They reported often feeling more authentic as trainee therapists, and enjoyed the challenge and results of helping men express and manage vulnerability. Working with the “macho man” exposed the discomfort and challenges that were present when working with hypermasculinity in therapy (such as managing misogyny, safety concerns, and boundaries), and opened a dialogue about the preparedness of trainees to work with men in their future career.

The challenges experienced by therapists in engaging and responding to help-seeking men have been documented in prior research (e.g. Almaliah-Rauscher, Ettinger, Levi-Belz, & Gvion, 2020; Seidler et al., 2021). This study extends on this prior work by highlighting that similar areas of discomfort and professional self-doubt are experienced by trainee therapists. Difficulties were noted in their efforts to sensitise therapy to best meet the needs of men identifying with traditional masculinities typified by emotional stoicism and the conflation of help-seeking with weakness. These findings likely reflect participants’ experiences of the common incongruence between traditional masculine socialisation and psychotherapy, where some therapists can express difficulty adapting their practice to facilitate engagement with men reticent to engage with their emotional vulnerability (Westwood & Black, 2012; Wong & Rochlen, 2005). This reinforces the value of therapist training, particularly for trainees, around strategies for adapting therapy to facilitate engagement with less emotionally literate men. This could include, as detailed by Silver, Levant, and Gonzalez (2018), training in the assessment and treatment of male normative alexithymia, to assist men lacking the awareness of, or literacy to describe, their emotions (Levant, 1992). It would also ensure trainee psychologists are conscious of how feelings of professional self-doubt influence their practice, particularly with respect to the significance attributed to drawing out men’s emotions in therapy. Participants’ satisfaction in uncovering men’s emotionality, reported in Breaking through, suggests that for some of these trainees, the act of drawing out emotion and vulnerability from men may serve as a barometer for therapeutic success and feelings of competence as trainees. Considering emotional suppression is correlated with greater psychopathology (Flynn, Hollenstein, & Mackey, 2010; Gross & John, 2003), such an appraisal is well-founded, however, it is likewise important to continuously evaluate whether these goals align with the client’s own aspirations and therapy journey.

Importantly, results themed under Mismatched expectations of manspeak raise implications for the therapeutic alliance if therapists approach male clients with preconceived sociocultural notions of how men may be challenged by the typical demands of therapy. This highlights the role of clinical psychology educators to support trainees to anticipate and effectively manage potential challenges in therapy with men without letting their gendered assumptions inadvertently perpetuate these challenges. This is especially important considering the main dichotomy in participants’ minds across our interviews seemed to be between traditionally masculine and therefore “difficult to engage” men, and those identifying less so with traditional norms, when a range of other axes of identity are known to influence engagement such as age (Boerma, Beel, Jeffries, & Ruse, 2023). In a study examining the relationship between trainee therapists’ expectations and actual outcomes for clients, Swift, Derthick, and Tompkins (2018) found that trainee therapists’ expectations about the therapeutic outcomes of their clients were significant predictors of change. This further exemplifies the need to incorporate a focus in psychology training around supporting students to identify and manage existing biases when working with men (Seidler et al., 2023).

Despite highlighting a need for trainees to take a critical view of their own expectations of working with men, the theme “Less psychobabble” underscored that the therapeutic approaches that trainees perceived as enjoyable and straightforward when working with men also correspond with the current best-practice recommendations for engaging male clients. For example, clinical treatment recommendations for working psychologically with men suggest the use of honesty, self-disclosure, informal language if appropriate (e.g. swearing), humour, conversational and colloquial dialogue, and male appropriate metaphors (American Psychological Association, 2018; Seidler, Rice, Ogrodniczuk, Oliffe, & Dhillon, 2018). All of these were variously highlighted by participants as elements of the work that they either instinctively employed or that they actively enjoyed being able to embody when working with men. This suggests that psychology training may benefit from assisting students to identify and build upon many of the intuitive microskills and client-specific adjustments they may already implement with men, to the extent that they align with best-practice engagement recommendations.

Results of this study also suggest that the reflective process itself contributed positively to how trainees may approach their work with men in the future. Many participants, unprompted, were explicit in underscoring the value they gained by participating in this study. They noted that such introspection enabled them to critically assess their preconceived notions and actual experiences when working with male clients. A previous study investigating the challenges that experienced therapists faced working with men similarly noted prejudice among some practitioners that many male clients are “ill-equipped for therapy” (Seidler et al., 2021). The current study found that therapists’ initial beliefs about men’s suitability for therapy was challenged after reflecting on their actual experiences. Absent such reflection, therapists might remain unaware of these subtleties and their influence on therapy. As O’Neil and Renzulli (2013) previously noted, therapists reflecting on their biases towards men is integral, and can prompt a more balanced and positive view of masculinity which ultimately results in better care for men. Whilst integrating male-specific training might require modifications to some university curriculums, results of the current study suggest reflective practice may also be a viable supplement or alternative in enabling trainee therapists to consider how they approach their work with men. This could achieve the dual benefit of improving trainee therapists’ work with men, alongside encouraging their practical embodiment of ethical standards of respect and equal opportunity for all clientele (e.g. Australian Psychological Society, 2007).

Despite the reported benefits of working with men, several female participants in the study referenced difficulties managing boundaries, misogyny, and a sense of safety when working with men. Appropriate responses to such challenges are important to understand given females make up nearly 80% of psychologists in Australia (Australian Government Department of Health, 2017) and are overrepresented in professional training programs (Gruber et al., 2021). Previous research highlighting the challenges that experienced therapists face with men (Seidler et al., 2021) revealed similar difficulties, where therapists had trouble managing misogyny, boundary setting, feelings of safety, and client anger. Given that these self-efficacy challenges seem to arise across different experience levels among Australian therapists, experience might not sufficiently equip trainees to handle these situations.

An important avenue to improving self-efficacy among trainee therapists here could be thoughtful supervised reflection on their reactions to, for example, men’s anger and gender-inequitable attitudes if these arise in therapy. Neither example should be perceived as inherently incompatible with a therapeutic alliance. Instead, training and supervision could focus on assisting trainee therapists to identify when and why they might perceive behaviours or attitudes among men as challenging, and how to prioritise therapeutic engagement in line with client goals even alongside attitudes with which therapists might disagree. Additionally, if discussing and/or challenging some men’s gender-inequitable attitudes is deemed appropriate to the therapeutic context and client goals and openness, this can allow for therapeutic encounters where men can reflect on whether such attitudes are helpful or harmful in their lives (Silver, Levant, & Gonzalez, 2018). This would also align with established recommendations around raising men’s awareness of gender-inequitable attitudes as a vehicle for feminist mental health promotion for men (American Psychological Association, 2018).

Limitations and future directions

Despite the novel nature of the current study and importance to future psychology training, findings must be considered in light of the following limitations. Firstly, participants were limited to students completing clinical psychology training in a single university. While Australian clinical psychology curricula are largely standardised according to national accreditation standards (Australian Psychology Accreditation Council, 2019), variations in institutional teaching approaches, faculty expertise, and student demographics mean the current findings may limit potential generalisability. The results observed here may also be specific to the types of male clients referred to trainee therapists. Men mandated for therapy to address violent behaviours, for example, may be less likely to be referred to trainee therapists. Participants in this study may have had a favourable experience working with men due, in part, to their lack of exposure to male clients with more challenging behaviours to work with.

Secondly, it is possible that students who volunteered to participate had a particular interest in the field, or specific views regarding working with men in their training. As such, their views may or may not be representative of all trainees. This may have contributed to the relatively homogenous perception of “men” in the current study, where limited diversity or difference between men was acknowledged aside from men’s degree of identification with traditional masculinities. The focus of the present study was on trainees’ experiences working with men in general as a foundational exercise. In future, research should thoughtfully aim to consider the role of intersectionality in the dynamic between client and trainee therapists here, as a range of identity axes including race, class and sexual orientation likely also influence experiences and therefore carry important implications for therapist training.

Thirdly, there was an overrepresentation of male participants (42%) relative to the Australian psychology workforce (20%; Australian Government Department of Health, 2017), which may have contributed to findings regarding the generally positive experiences engaging men among trainees. Indeed, male therapists in prior research tend to report greater self-efficacy related to engagement of male clients relative to female therapists (Seidler et al., 2023). Given the interviewer was also a trainee psychologist himself at the same institution as participants (and in the same cohort as a subset), this may have influenced the findings observed. Some participants might have felt more comfortable disclosing certain experiences working with men due to the assumption of, or actual shared experience with the interviewer. Member checking should also be offered in future studies to enhance trustworthiness of the data.

Conclusion

This study is the first to explore how trainee psychologists experience psychotherapeutic work with men. This study spotlights the importance of refining clinical psychology training to address the distinct needs of male clients. Future research should concentrate on developing and evaluating specific educational interventions within university curricula that equip trainees with the skills to better engage with men in therapy. These interventions must directly confront and demystify the implications of masculine socialisation on therapeutic processes. Additionally, there is a need for the creation of curriculum content that prepares trainees to navigate the safety and ethical challenges encountered when working with male clients who conform strongly to hypermasculine gender roles.

Practical implications

This study is the first to unpack the experiences of trainee therapists working with male clients. Results highlight areas of uncertainty, such as assisting men with limited emotional literacy. Trainee therapists also described approaching psychotherapy with men with a range of expectations and prejudices that could inadvertently reinforce traditional masculine norms. These findings speak to value of targeted education for trainee therapists around engaging and responding effectively to male clients.

Acknowledgments

The Authors wish to thank all participants for their participation in this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Raw data on which this manuscript is based are not available to share in line with the bounds of ethical approval.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09515070.2024.2373474

Additional information

Funding

This work was supported by Deakin University as part of its support for research undertaken by clinical psychology students.

Notes on contributors

Jerome Scaffidi

Jerome Scaffidi recently completed his Master of Psychology (Clinical) with Deakin University. His research interests have focused on male mental health.

Michael J. Wilson

Michael J. Wilson is a researcher focused on men’s mental health and suicide prevention, based with Orygen at the University of Melbourne. His research interests include adolescent masculinity, engaging and responding to help-seeking men, and understanding risk and protective factors associated with suicidal thoughts and behaviours in men. His current PhD research focuses on understanding men’s risk of suicidal thoughts and behaviours following relationship breakdown.

Zac E. Seidler

Zac E. Seidler received his Master of Psychology (Clinical) and PhD from the University of Sydney, Australia. He currently works in a dual role as both a senior research fellow with Orygen, at The University of Melbourne, and as the Global Director of Men’s Health Research at Movember. His areas of professional interest include men’s mental health, suicide and gender-based health system reform.

Melissa O’Shea

Melissa O’Shea (she/her) is an Associate Professor of Clinical Psychology and leads postgraduate clinical psychology training at Deakin University. She is a clinical psychologist and holds qualifications in clinical leadership and is passionate about developing work ready clinical psychology graduates. Her research interest include innovation in teaching and learning in professional psychology and integrative psychology.

Notes

1. Professional placements in Australian psychology training programs typically occur two to three days per week over fifteen to twenty weeks (Australian Psychology Accreditation Council, 2019). Students completing a Masters in Clinical Psychology complete a minimum of three placements over two years and students completing a Doctor of Clinical Psychology complete a minimum of four placements over three years (Australian Psychology Accreditation Council, 2019).